Provider Demographics
NPI:1356961403
Name:PAYTON, KENDRA N (LMSW)
Entity type:Individual
Prefix:
First Name:KENDRA
Middle Name:N
Last Name:PAYTON
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19131 VERONICA AVE
Mailing Address - Street 2:
Mailing Address - City:EASTPOINTE
Mailing Address - State:MI
Mailing Address - Zip Code:48021-2794
Mailing Address - Country:US
Mailing Address - Phone:313-333-2927
Mailing Address - Fax:
Practice Address - Street 1:19131 VERONICA AVE
Practice Address - Street 2:
Practice Address - City:EASTPOINTE
Practice Address - State:MI
Practice Address - Zip Code:48021-2794
Practice Address - Country:US
Practice Address - Phone:313-333-2927
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-19
Last Update Date:2020-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010977451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical